Trust-Level Risk Evaluation and Risk Control Guidance in the NHS East of England

In recent years, the healthcare sector has adopted the use of operational risk assessment tools to help understand the systems issues that lead to patient safety incidents. But although these problem-focused tools have improved the ability of healthcare organizations to identify hazards, they have not translated into measurable improvements in patient safety. One possible reason for this is a lack of support for the solution-focused process of risk control. This article describes a content analysis of the risk management strategies, policies, and procedures at all acute (i.e., hospital), mental health, and ambulance trusts (health service organizations) in the East of England area of the British National Health Service. The primary goal was to determine what organizational-level guidance exists to support risk control practice. A secondary goal was to examine the risk evaluation guidance provided by these trusts. With regard to risk control, we found an almost complete lack of useful guidance to promote good practice. With regard to risk evaluation, the trusts relied exclusively on risk matrices. A number of weaknesses were found in the use of this tool, especially related to the guidance for scoring an event's likelihood. We make a number of recommendations to address these concerns. The guidance assessed provides insufficient support for risk control and risk evaluation. This may present a significant barrier to the success of risk management approaches in improving patient safety. © 2013 Society for Risk Analysis.

Elevated ability to compete for limited food resources by 'all-fish' growth hormone transgenic common carp Cyprinus carpio

Food consumption, number of movements and feeding hierarchy of juvenile transgenic common carp Cyprinus carpio and their size-matched non-transgenic conspecifics were measured under conditions of limited food supply. Transgenic fish exhibited 73 center dot 3% more movements as well as a higher feeding order, and consumed 1 center dot 86 times as many food pellets as their non-transgenic counterparts. After the 10 day experiment, transgenic C. carpio had still not realized their higher growth potential, which may be partly explained by the higher frequency of movements of transgenics and the 'sneaky' feeding strategy used by the non-transgenics. The results indicate that these transgenic fish possess an elevated ability to compete for limited food resources, which could be advantageous after an escape into the wild. It may be that other factors in the natural environment (i.e. predation risk and food distribution), however, would offset this advantage. Thus, these results need to be assessed with caution.

Articulating current service development practices: a qualitative analysis of eleven mental health projects.

BACKGROUND: The utilisation of good design practices in the development of complex health services is essential to improving quality. Healthcare organisations, however, are often seriously out of step with modern design thinking and practice. As a starting point to encourage the uptake of good design practices, it is important to understand the context of their intended use. This study aims to do that by articulating current health service development practices. METHODS: Eleven service development projects carried out in a large mental health service were investigated through in-depth interviews with six operation managers. The critical decision method in conjunction with diagrammatic elicitation was used to capture descriptions of these projects. Stage-gate design models were then formed to visually articulate, classify and characterise different service development practices. RESULTS: Projects were grouped into three categories according to design process patterns: new service introduction and service integration; service improvement; service closure. Three common design stages: problem exploration, idea generation and solution evaluation - were then compared across the design process patterns. Consistent across projects were a top-down, policy-driven approach to exploration, underexploited idea generation and implementation-based evaluation. CONCLUSIONS: This study provides insight into where and how good design practices can contribute to the improvement of current service development practices. Specifically, the following suggestions for future service development practices are made: genuine user needs analysis for exploration; divergent thinking and innovative culture for idea generation; and fail-safe evaluation prior to implementation. Better training for managers through partnership working with design experts and researchers could be beneficial.

mHealth and global mental health: still waiting for the mH2 wedding?

BACKGROUND: Two phenomena have become increasingly visible over the past decade: the significant global burden of disease arising from mental illness and the rapid acceleration of mobile phone usage in poorer countries. Mental ill-health accounts for a significant proportion of global disability-adjusted life years (DALYs) and years lived with disability (YLDs), especially in poorer countries where a number of factors combine to exacerbate issues of undertreatment. Yet poorer countries have also witnessed significant investments in, and dramatic expansions of, mobile coverage and usage over the past decade. DEBATE: The conjunction of high levels of mental illness and high levels of mobile phone usage in poorer countries highlights the potential for "mH(2)" interventions--i.e. mHealth (mobile technology-based) mental health interventions--to tackle global mental health challenges. However, global mental health movements and initiatives have yet to engage fully with this potential, partly because of scepticism towards technological solutions in general and partly because existing mH(2) projects in mental health have often taken place in a fragmented, narrowly-focused, and small-scale manner. We argue for a deeper and more sustained engagement with mobile phone technology in the global mental health context, and outline the possible shape of an integrated mH(2) platform for the diagnosis, treatment, and monitoring of mental health. SUMMARY: Existing and developing mH(2) technologies represent an underutilised resource in global mental health. If development, evaluation, and implementation challenges are overcome, an integrated mH2 platform would make significant contributions to mental healthcare in multiple settings and contexts.

The algae-lytic ability of bacterium DC10 and the influence of environmental factors on the ability

A lysing-bacterium DC10, isolated from Dianchi Lake of Yunnan Province, was characterized to be Pseudomonas sp. It was able to lyse some algae well, such as Microcystis viridis, Selenastrum capricomutum, and so on. In this study, it was shown that the bacterium lysed the algae by releasing a substance; the best lytic effects were achieved at low temperatures and in the dark. Different concentrations of CaCl2 and NaNO3 influenced the lytic effects; the ability to lyse algae decreased in the following order: pH 4 > pH 9 > pH 7 > pH 5.5. It was significant to develop a special technology with this kind of bacterium for controlling the bloom-forming planktonic microalgae.

Glass formation ability and mechanical properties of Ti40Cu40Zr10Ni10 alloy

Melt-spun ribbon and bulk samples in cylindrical rod form with diameter ranging from 2 mm to 4 mm of Ti40Cu40Zr10Ni10 alloy were prepared by melt-spinning technique and copper mould casting method, respectively. The microstructure, thermal stability and mechanical properties of the bulk samples were investigated. A completely glassy single phase is formed in the 2 mm rod sample. Increasing the diameter of the rod samples resulted in the formation of CuTi crystalline phase in the 3 mm and 4 mm rod samples.

Near infrared long lasting emission of Yb3+ and its influence on the optical storage ability of Mn2+-activated zinc borosilicate glasses

The near infrared long lasting phosphorescence of Yb3+ is observed in Yb3+ and Mn2+ codoped zinc borosilicate glasses. Compared with the glasses solely activated by Mn2+, when the Yb3+ ion is codoped, the red long lasting phosphorescence of the samples is largely improved in both brightness and persistent time but the photostimulated long lasting phosphorescence is greatly depressed. It is considered that the appearance of the phosphorescence of Yb3+ is due to the alteration of the energy transfer channel; additionally, Yb3+ also changes the trap depth of the glasses with the shallower trap predominating therefrom the red long lasting phosphorescence is improved and the photostimulated long lasting phosphorescence is degraded.

A comparison of electrocatalytic ability of various mediators adsorbed onto paraffin impregnated graphite electrodes for oxidation of reduced nicotinamide coenzymes

Twelve mediators have been modified by adsorption onto the paraffin impregnated graphite electrodes (IGE). The resulting electrodes exhibit electrocatalytic activity of different degrees towards oxidation of 1,4-dihydronicotinamide adenine dinucleotide (NADH). The electrocatalytic ability of the chemically modified electrode (CME) depends mainly on the formal potential and molecular structure of mediator. The formation of the charge transfer complex between NADH and adsorbed mediator has been demonstrated by the experiments using a rotating disk electrode. An electrocatalytic scheme obeying Michaelis-Menten kinetics has been confirmed, and some kinetic parameters were estimated. The solution pH influences markedly the electrocatalytic activity of the modified electrode. Various possible reasons are discussed.

Toughening mechanism of polymer blends: Influence of voiding ability of dispersed-phase particles

The parameters which effect the cavitation strain of polymer blends toughened with a shear yield mechanism have been studied by analysis of the stress acted on the equatorial plane of dispersed-phase particles. As a result, the cavitation strain of polymer blends depends on the Young's modulus and the Poisson's ratio of the dispersed-phase particles and the matrix and also on the break stress of dispersed-phase particles. We tried to provide a criterion for selecting the materials used as dispersed-phase particles which can effectively enhance the toughness of polymer blends. (C) 1996 John Wiley & Sons, Inc.

A bioaugmentation failure caused by phage infection and weak biofilm formation ability

Two biological aerated filters (BAF) were setup for ammonia removal treatment of the circulation water in a marine aquaculture. One of the BAFs was bioaugmented with a heterotrophic nitrifying bacterium, Lutimonas sp. H10, where the ammonia removal was not improved and the massive inoculation was even followed by a nitrification breakdown from day 9 to 18. The nitrification was remained stable in control BAF operated under the same conditions. Fluorescent in situ hybridization (FISH) with rRNA-targeted probes and cultivable method revealed that Lutimonas sp. H10 almost disappeared from the bioaugomented BAF within 3 d, and this was mainly due to the infection of a specific phage as revealed by flask experiment, plaque assay and transmission electron observation. Analyses of 16S rRNA gene libraries showed that bacterial groups from two reactors evolved differently and an overgrowth of protozoa was observed in the bioaugmented BAR Therefore, phage infection and poor biofilm forming ability of the inoculated strain are the main reasons for bioaugmentation failure. In addition, gazing by protozoa of the bacteria might be the reason for the nitrification breakdown in bioaugmented BAF during day 9-18.

Transporting nutrients from sediments: nitrogen and carbon as indicators to measure scavenging ability of a detritivorous fish, Liza haematocheila

The redlip mullet, Liza haematocheila, is a common species in polyculture as a scavenger in China. Feeding on detritus, redlip mullet transports nutrients from sediments up into the water column and converts them into forms that can be utilized by phytoplankton and affects the relative abundance of detritus and dissolved inorganic nutrients to phytoplankton, zooplankton and other fishes. We used nitrogen and carbon as the indicators in this study to measure the scavenging ability, which means intake of nitrogen or carbon by redlip mullet, and the loss of nutrients. Temperature and body weight significantly affected growth nitrogen, faecal nitrogen and faecal carbon. At a certain temperature, the proportion of growth nitrogen or growth carbon increased while the proportion of excretion nitrogen or respiration carbon decreased with increasing body weight.

本科实习男护生压力源、应对方式与心理健康关系的研究

Objectives:To investigate stressor and stress level,coping styles and mental health of male nursing undergraduates in clinical practice;To find out the factors that influence mental health of male nursing undergraduates in clinical practice and to put forward some suggestions to improve the mental health status of male nursing undergraduates. Methods: After doing many literaturere search both at home and abroad,I gather further consulting many nursing undergraduates in clinical practice,Finally I formulate the “Nursing Student's Clinical Stressor Scale”.80 male nursing ungraduates from Bengbu Medical Colledge were recruited. While 140 female nursing ungraduates who were in clinical practice in the same period of time were taken as a comparative group.The following questionnaire package including a background questionnair,Nursing Student's Clinical Stressor Scale NSCSS,Simplified Coping Style Questionnaire SCSQ,The Symptom Checklist 90 SCL-90 were distributed and collected together in the 14th week during the clinical practice.Of the 220 questionnaires were distributed and 198 were found to valid,the valid callback rate was 92%.The endudeed 77 were male and 121 were female .Statistices analysis was performed by SPSS13.0 and AMOS5.0 software. Results： 1.25% of male nursing undergraduates had a higher level of stress, mainly from employment,major,working nature,working contents and so on.Compared with female nursing undergraduates,male nursing undergraduates underwent a higher pressure in the employment and the profession aspect,but lower in their insufficient knowledge and ability.There was a significant negative correlation between the male undergraduates’ stress level and their satisfaction degree to clinical nursing teaching and the professional title of the clinical teachers,but it was positively correlated with their family monthly income. Stress level of female nursing undergraduates positively related with the number of children in their families,but negatively correlated with their family monthly income; 2.Male nursing undergraduates' coping style both positive and negative coping styles were adopted by male nursing undergraduates but mean at while positive coping styles.The positive coping styles adopted by male nursing undergraduates were significantly lower than that adopted by female nursing undergraduates; 3.The scores of depression,interpersonal sensitivity and anxiety in male nursing undergraduates were significantly higher than those of the nationwide youths norm.Alist all subscales scores of male nursing group were more than those of female nursing undergraduates except for fear subscale. Mental health of male nursing undergraduates was inversly correlated with the professional title of the clinical teachers and satisfaction of their majors; 4.Among male nursing undergraduates,the total score of stress and most subscale(except working nature and working contents,employment)scores of stress were positively correlated with the negative coping styles.The scores of stress level was positively correlated with the scores of SCL-90,Negative coping styles was positively correlated with the scores of SCL-90 among male nursing undergraduates,while positive coping styles were inversly correlated with most subscales(except phobic,paranoia,psychoticism)scores of SCL-90. Conclusions： 1.25% male nursing undergraduates have a higher level of stress,which is from employment, profession,working nature and working contents,financial difficulties and so on.The coping styles adopted by male nursing undergraduates were mainly positive coping styles.The mental health of male nursing undergraduates were lower; 2.Different genders have significant differences between stressors, coping style and mental health; 3.Stress,coping style,satisfaction degree to clinical nursing teaching and the professional title of the clinical teachers are predietors of mental health among male nursing undergraduates.

中学生抑郁和素质、压力、环境因素的关系及其整合模型研究

As a kind of mood, depression is one of the emotions which people experienced usually. Depressive disorder is one of the common mental diseases. There are about 100 million people in the world be disturbed by depression every year. So it is long history that depression is investigated widely in medicine, psychology, and sociology. There are many theorial problems remain to be solved. Viewed from latest vocuments, the development of depression theory is tending to become more complicated. Most of the prior depression theory focused on relation between one factor and depression. Because depressed individuls have various characteristics and factors that cause depression are different, and each factor can explain only part of depression variance, these prior depression theories are defected. As the knowledge about depression accumulated, the view that depression be caused by multifactor is clearer. There is tendency to integrate these cooperational factor into a model while developing a depression theory. In the present study, depression status of 1625 middle school students from junior 1 to senior 3 are measured using Depression Scale of Middle-school Student which is developed by ourselves. From approach of depressive mood, the present study explored depressive diathesis including attributional style, personality, coping style, and self. The relation among depressive diathesis, stress and depression is analysed. The relation between depression and school life adaptation, depression and cohesion, adaptation in family are also analysed from environmental view. At last, relation among environment, stress, depressive diathesis is examined by using covariance structure modelling. Synthesizing the results from the present study, the following conclusions were drawn: (1) There is grade-characteristics in development of depression in middle school students. Depression degree increased with grade. The main reason may be that the stress middle-school students experience increase and self-acceptance decrease with grade; (2) High depressive diathesis is different from low depressive diathesis. the features of high depressive diathesis are that attributing failure to ability or background, low capacity for status, low sociability, low independence, low self-blame, more illusion. The features of low depressive diathesis are that not attributing failure to ability or background, high capacity for status, high sociability, high independence, high self-acceptance, while facing difficulties, using problem-resolving coping strategy, less self-blame, less illusion. Individuals who have high depressive diathesis showed serious depression, and individuals who have low depressive diathesis showed light depression; (3) Depressive diathesis had accumulative effect on depression. More low depressive diathesis, more light is depression. More high depressive diathesis, more serious is depression; (4) Depressive diathesis can predict present depression and future depression. Predicting present depression is more effective than predicting future depression; (5) Individual who has different depressive diathesis experiences different level of stress. Higher the depressive diathesis individual has, higher stress he will experience. Lower the depressive diathesis individual has, lower stress will he experience; (6) There is correlation between life event pressure and depression. Life event pressure can predict a part of variance of depression. Life event pressure has accumulative effect on depression. More life event and higher life event pressure, more serious depression individual will experience; (7) There exits high correlation between depression and school life adaptation which can predict depression; (8) There is high correlative relation between depression and cohesion, adaptation in family which can predict depression; and (9) Environment have more effect on diathesis than on stress. Diathesis has more effect on depression than stress does. The past depression can predict future depression. This study had enlarged the domain of depressive diathesis such as attributional style, personality, coping style, and self, which are analysed wholly. This study had also enriched the connotation of diathesis=stress theory. Above two aspects are theoretical significance of the study. This study provide a framework of mental health educational curriculum in high school and provide the guideline for prevention and cure of depression. It is the practical significance of this study.